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However, if your doctor finds a cataract, you may not need cataract surgery for several years. Have your vision tested regularly. When a cataract interferes with normal activities you should consider surgery. Many people with cataracts are able to use vision aids, such as spectacles, to avoid or delay surgery. People who depend greatly on their eyes for work and leisure activities may want their cataracts removed earlier than others.
Cataract surgery is safe, fast and virtually painless and one of the most common surgeries performed. Improvement in vision after surgery depends on the initial health of the eye and the operative result. Certain diseases of the retina can limit the final visual result.
Surgery involves replacing the clouded lens with an implanted clear plastic, acrylic or silicone intraocular lens (IOL). The implant is placed in or near the original position of the removed natural lens, so vision is restored with good peripheral vision and depth perception, yet with minimal magnification and distortion. IOLs remain permanently in place, require no maintenance or handling, and are neither felt by the recipient nor noticed by others. Spectacles with thin lenses for near or distant viewing may still be required.
One of the disadvantages of IOLs is the fixed focus of the lens, meaning the patient can only see far or only near. New developments in IOLs are the development of multifocal IOLs that provide refractive correction for close vision and distance, so that patients do not lose their accommodative ability. There are some disadvantages to multifocal IOLs, like reduction in contrast sensitivity, presence of glare and halos, especially at night. You ophthalmologist will discuss these advantages and disadvantages with you before deciding to implant a multifocal IOL.
Preparation for surgery
Once you and your ophthalmologist (eye specialist) have decided on cataract surgery, you will be measured for the appropriate lens implant (specific to each patient) and the surgery date will be set.
Procedure for implantation of an IOL
The procedure is carried out under general or local anaesthetic. Looking through an operating microscope, the surgeon makes a minute incision in the surface of the eye. The clouded lens is emulsified with an ultrasonic probe and suctioned out of the eye, usually leaving intact the rear wall of the transparent capsule that encloses the lens.
The new lens – a clear, plastic disc – is placed behind the iris and up against the back wall of the capsule. Two tiny C-shaped arms attached to the lens hold the lens firmly in place. The incision is closed with tiny, nearly invisible stitches or in some cases no sutures are needed. The whole operation usually takes less than an hour.
Post-operative recovery
One usually starts using the eye the morning after surgery. Vision is usually remarkably clear the day after the procedure and improves over the following weeks.
You can resume most of your normal activities, but will be asked to minimise lifting, bending and straining for the month after surgery. You should avoid getting water in the operated eye for one to two weeks.
Following surgery, you should wear a protective eye shield at night for at least two weeks after surgery to prevent rubbing of the eye during sleep.
Returning to work and driving varies from one patient to another. Many people are back at work a few days after the operation.
During the first six to eight weeks after surgery the doctor checks for infections or other complications and fits you for glasses. To prevent infection and reduce inflammation, your physician may recommend that you apply antibiotic and steroid ointments or drops to your eye. Risks associated with cataract surgery include complications such as bleeding, infection, swelling of the cornea, glaucoma, swelling of the retina, and retinal detachment, which can occur during or after surgery in a small percentage of people.
Once the cataract has been removed, it does not recur. Some patients may develop thickening of the capsule behind the new lens implant, which causes blurred vision. However, this thin film can easily be treated with a laser and does not require repeat surgery. This painless procedure takes a few minutes and improvement is usually immediate.
A lens implant will not wear out and should last a lifetime.
Leaving a cataract in the eye is not dangerous, but with time cataracts do increase in size and hardness and cause progressively worsening vision.
